Surgical instrument



Jan. I, 1963 1. F. WASSERMAN SURGICAL INSTRUMENT Filed Feb. 23, 1961 ON N I Q m- N QN mm mm mm ON mm on N MWNQN .6; T? a fitates Patent 3,671,129 SURGICAL HJSTRUMENT lsio F. Wasserman, 264 Gcnesee St., Utica, N.Y. Filed Feb. 23, 1% Ser. No. 91,220 (Ilaims. (Cl. 12S--6) This invention relates to a surgical instrument which is especially well suited for insertion into cavities or passages in the body of a patient to permit direct visualization cf internal areas and the carrying out of surgical procedures. More particularly, this invention relates to a surgical instrument for carrying out sigmoidoscopy.

Instruments constructed in accordance with the present invention are particularly advantageous in carrying out visual examinations and surgical procedures in internal passages of the body where body fluids or other matter may interfere, particularly by obscuring the area which is to be observed. For example, difficulty is often en countered with conventional instruments in carrying out sigmoidoscopy in spite of the fact that the patient may have been carefully prepared before hand. Obscuration of the area desired to be viewed may and often does occur after a procedure has been started and with conventional instruments this usually results in substantial delay and interference. When the procedure involves a biopsy for the purpose of identifying malignancy, specimens of tissue are usually required from the suspicious areas. Bleeding resulting from the removal of tissue from one area often results in the masking of other areas as well. Furthermore, unless the blood is effectively removed electroful- .guration of the bleeding area is rendered quite difficult and dangerous because of the imperfect visualization of the area involved.

It is, therefore, a principal object of this invention to provide an improved yet relatively simple surgical instrument which is especially well suited for use as a sigmoidoscope and which minimizes the possibility of delay in carrying out surgical procedures because of improper or incomplete preparation of the patient or because of bleeding which may occur during the procedure.

It is a further object of this invention to provide such an instrument by means of which unwanted fluids and matter may be continuously removed so as to prevent their interfering with observation of the desired area and which facilitates the introduction and removal of such fluids as cleansing liquids and insufllating gases.

A surgical instrument constructed in accordance with the present invention is characterized by a circular orifice which extends throughout 360 about an inner opening. Suction may be applied to remove fluids or other matter from an area through the orifice While the area is observed and/ or treated through the central opening. One preferred embodiment of the present invention comprises two concentric elongated tubular members, both of which are open at their distal ends. The two tubes are joined together adjacent to their proximal ends with the outer tube being closed at its proximal end except that it communicates with a stop-cock. The assembly is provided with a suitable fitting at its proximal end by means of which an obturator and an auxiliary tubular member carrying a suitable eyepiece may be attached. Preferably provision is made for illuminating the area under view by means of a light source which communicates generally laterally with the observation channel intermediate the proximal and distal ends of the instrument. The outer tubular member forms the circular orifice about the opening at the distal end of the inner tube. Thus, with the stopcock connected to a suction device, suction is applied substantially throughout 360 about the area under view through the inner opening, to withdraw matter therefrom and keep it clear for observation or treatment.

Further objects as well as advantages of the present invention will be apparent from the following description of a preferred embodiment thereof and the accompanying drawing in which:

FIGURE 1 is an elevational view of a sigmoidoscope constructed in accordance with the present invention;

FIGURE 2 is a similar view partially in section and partially broken away for convenience with the eyepiece section detached from the body of the instrument; and

FIGURE 3 is a sectional view along the line 3-3 of FIGURE 1.

A preferred embodiment of a sigmoidoscope 10 may be constructed as shown in the drawing in. connection with which it will now be described. Sigmoidoscope 10 comprises an elongated, open-ended tubular member 11 to which is fixed, adjacent to its proximal end, a collar 12 forming a circular space 13 with the tubular member 11. A conduit 14' having a stopcock assembly 14 connected thereto communicates through the collar 12 with the space 13 and may as shown be coupled to tubing 15 which in turn may be connected to a suction or other device as Will be more fully pointed out. The stopcock assembly 14 is provided with ring 16 forming a finger hole so that the operator may readily control the suction applied through the instrument when intermittent suction is desired.

An outer tubular member 17 is concentrically mounted about the inner tubular member 11 and is anchored and closed at its proximal end by threaded engagement with the collar 12 as indicated at 13. The inner diameter of tubular member 17 is somewhat greater than the outer diameter of the inner tubular member 11 so that these tubular members form an elongated channel 19 thereetween one end of which communicates through the space 13 with the stopcock 14.

At its distal end 2%, the outer tubular member 17 overhangs the inner tubular member 11 and is turned inwards so as to present a smoothly rounded exterior. The adjacent distal end 21 of the tubular member 11 forms a circular orifice 22 with the end 2% of tubular member 17. In order to preserve the generally concentric spacing of the distal ends of the tubular members 11 and 17, several centering lugs 23 may be provided between their distal end portions. it is to be noted that the opening at the end 2% of the outer tubular member has a slightly smaller diameter than that at the end of the inner tubular member 11 and is spaced therefrom. The arrangement minimizes the possibility of the mucosa being drawn into and blocking the orifice 22 when suction is applied.

The proximal end 24 of the inner tubular member 11 is tapered and is provided with a bayonet stud 25. A tubural eyepiece member 26 is provided with a com plementary internally tapering surface 27 and a slot 23 for engaging the stud 25 by means of which the eyepiece 26 and the tubular member 11 are joined in fluid tight relation. The proximal end of the eyepiece member 26 is sealed by a movably mounted ring 29 in which an ocular lens 30 is sealed. The ring 29 is pivotally connected to the flanged proximal end of the eyepiece 26 by means of a pivot pin 38. The abutting surfaces of the ring 29 and the eyepiece 26 are polished so that with the ring and the lens 30 carried thereby closed and clamped by a flat spring 39 on the eyepiece a fluid tight seal is provided.

A tubular lamp housing 31 extends laterally an obliquely from the eyepiece member 26 and is threaded to receive a lamp holder 32. As shown the lamp housing 31 opens into the interior of the eyepiece member 26 and a lamp 33 is positioned in this opening.

The eyepiece member 26 is provided with a conduit 35 and a stopcock 36 communicating through an opening in its wall with its interior which permits insufflation by a fluid such as air.

Graduations 37 are spaced along and extend entirely around the exterior surface of the outer tubular member to provide a convenient indication of the extent to which the instrument has been inserted.

When it is desired to introduce the instrument into the body of a patient, ring 29 with lens 3% is released from clamp 39 and rotated about the pivot 38 to open the proximal end of the instrument through which an obturator provided with a male bayonet fitting is inserted and locked in place by engagement of its stud in slot 40 formed in the tapered inner surface of the eyepiece 26. The conventional rounded nose of the obturator projects through and closes the open distal end of the outer tubular member 17. Once the instrument has been introduced into the body of the patient with the usual technique, the obturator is removed and the lens 3% may be restored to its closed position. The area presented to the open proximal end of the inner tubular member 11 is illuminated by the lamp 33 and is conveniently examined through the magnifying lens 30. When the area under view is obscured by blood, fumes, or intestinal matter, the tube 15 is connected to a suction device. The stopcock 14 has three positions, a closed position, an open position in which the finger hole ring 16 is closed and the conduits 14 and 15 are in communication and a second open position in which conduits 14 and 15 are in communication with each other and the finger hole. With the stopcock in its last mentioned position, intermittent suction is readily applied by obstructing and opening the finger hole. An important advantage of the present instrument resides in the fact that suction is applied concentrically about the entire area under view and any fluid or matter which would obstruct or obscure visualization is carried away through the circular orifice 2. channel 19, conduit 14 and stopcock 14.

In the event incomplete evacuation of the patient should interfere with the procedure, the lens 30 may be shifted to its open position and a saline or sodiurnphosphate solution may be introduced into the bowels and then removed through the orifice 22 by suction. If desired, the irrigating solution may be introduced through stopcock 36 and conduit 35 into the inner tubular member 11 and may be withdrawn through the circular orifice 22 with stopcock 14 to suction. The irrigating solution may also be introduced by connecting an injection machine to conduit 15 and may be withdrawn by connecting the conduit 15 to suction.

Hitherto such procedures as electrofulguration have proven to be extremely hazardous because of intestinal rupture resulting from explosion of the highly inflammable gas concentration usually present in the bowels. It has been proposed to introduce an inert gas in order to minimize the danger of an explosion. With the circular orifice 22 connected to suction through the stopcock 14 the introduction and removal of such inert gas is facilitated. Furthermore, smoke created during the operation is rapidly withdrawn and is prevented from obscuring the area undergoing treatment.

The instrument of the present invention also facilitates insufflation where distention of the cavity under examination is desired. For this purpose a source of suitable insufllating fluid may be connected to the stopcock 36 and with stopcock l4 and lens 3i) closed the instrument is fluid tight.

It is to be noted that the introduction and removal of fluids is accomplished without interfering with or obstructing the field of view of the instrument. The arrangement of the instrument is such as to facilitate the carrying out of various procedures by, among other things, providing a marked degree of freedom for the operating surgeon and by minimizing or eliminating delays which hitherto resulted from obscuration of the area undergoing observation and treatment.

The length and the diameter of the tubular members 11 and 17 may be varied to adapt the instrument for insertion into openings and passageways of widely varying dimensions. The surgeon is advantageously equipped with a number of such assemblies of the tubular members of different sizes all of which are equipped with a male bayonet fitting as shown at 24 adapted to be received in the distal end of the eyepiece 25 which may be transferred from one to another as required. Thus only one eyepiece is required for use with all of the tubular member assemblies. The obturator used with the instrument is conveniently made adjustable in length to fit the differently sized assemblies by arranging the male bayonet connector so that it may be slid along the obturator shaft toward or away from the rounded obturator nose and clamped in place where desired.

The terms and expressions which have been employed are used as terms of description and not of limitation, and there is no intention, in the use of such terms and expressions of excluding any equivalents of the features shown and described or portions thereof, but it is recognized that various modifications are possible within the scope of the invention claimed.

I claim:

1. A surgical instrument, comprising a pair of tubular members, means connecting said tubular members with one positioned within the other and with their distal ends adjacent to each other and forming a circular orifice therebetween, a third tubular member removably connected adjacent to one end thereof to the proximal end of the inner tubular member, an optical lens closing said third tubular member for viewing an area presented to the distal end of said inner tubular member, means connected to and extending into said third tubular member intermediate the ends thereof for illuminating said area, a fluid conduit connected to said third tubular member and communicating therethrough with the interior of said inner tubular member, means connected to the outer tubular member adjacent to the proximal end thereof and communicating through the space between said tubular members with said orifice for selectively connecting the same to a suction device and a source of fluid under pressure, the distal end portion of the outer tubular member overhanging the corresponding end of said inner tubular member and forming an opening which is smaller than and spaced from that at the end of said inner tubular member.

2. A surgical instrument particularly for carrying out sigmoidoscopy, comprising first and second coaxial tubular fluid conduits with the second tubular conduit extending spaced from and about said first tubular conduit, said first tubular conduit defining an observation channel open at the distal end thereof, means closing the proximal end of said first tubular conduit comprising means for illuminating and viewing an area presented to the distal end thereof, a collar encircling said first tubular conduit adja cent to its proximal end, said second tubular conduit being connected at its proximal end to said collar and being supported thereby in spaced relation about said first tubular conduit, the distal end of said second tubular conduit being in close spaced relation with the corresponding end of said first tubular conduit and forming therewith a circular orifice extending entirely about the open distal end of said first tubular conduit, a third conduit communicating through said collar and the space between said tubular conduits with said orifice, said third conduit being adapted to be connected to a suction device, and means connected to said third conduit for controlling the suction applied to said orifice.

3. A surgical instrument particularly for carrying out sigmoidoscopy, comprising first and second coaxial tubular members with the second tubular member extending spaced from and about said first tubular member, said first tubular member defining an observation channel open at the distal end thereof, a collar connected to and extending in spaced relation about said first tubular member adjacent to its proximal end, said second tubular member being connected at its proximal end to said collar and being supported thereby in spaced relation about said first tubular member, the distal end of said second tubular member being in close spaced relation with the corresponding end of said first tubular member and forming therewith a circular orifice extending about the open distal end of said first tubular member, a conduit communicating through said collar and the space between said tubular members with said orifice, said conduit being adapted to be connected to a suction device, means connected to said conduit for controlling the suction applied to said orifice, a third tubular member removably connected adjacent to one end thereof to the proximal end of the first tubular member, an optical lens closing said third tubular member for viewing an area presented to the distal end of said first tubular member, means connected to and extending into said third tubular member spaced from the ends thereof for illuminating said area, and a fluid conduit connected to said third tubular member and communicating therethrough with the interior of said first tubular member.

4. A surgical instrument particularly for carrying out sigmoidoscopy, comprising first and second coaxial tubular members with the second tubular member extending spaced from and about said first tubular member, said first tubular member defining an observation channel open at the distal end thereof, a collar connected to and extending in spaced relation about said first tubular member adjacent to its proximal end, said second tubular member being connected at its proximal end to said collar and being supported thereby in spaced relation about said first tubular member, the distal end portion of said second tubular member being turned inward and extending beyond the corresponding end of said first tubular member and forming therewith a circular orifice extending about the open distal end of said first tubular member, a conduit communicating through said collar and the space between said tubular members with said orifice, said conduit being adapted to be connected to a suction device, means connected to said conduit for controlling the suction applied to said orifice, a third tubular member removably connected adjacent to one end thereof to the proximal end of the first tubular member and forming an extension thereof, an optical lens closing said third tubular member for viewing an area presented to the distal end of said first tubular member, a lamp housing connected to and projecting laterally from said third tubular member spaced from the ends of the latter, said lamp housing communicating through the wall of said third tubular member, and a fluid conduit connected to said third tubular member and communicating therethrough With the interior of said first tubular member.

5 A surgical instrument as set forth in claim 4 wherein said means connected to said conduit for controlling the suction applied to said orifice comprises a threeposition stop cock having a finger hole, said stop cock having an open position in which said finger hole communicates with said conduit, and said stop cock being positioned adjacent to the proximal end of said instrument.

References Cited in the file of this patent UNITED STATES PATENTS 1,345,406 Rimmer July 6, 1920 1,624,716 Cerbo Apr. 12, 1927 2,243,285 Pope May 27, 1941 2,516,494 Wallace July 25, 1950 

1. A SURGICAL INSTRUMENT, COMPRISING A PAIR OF TUBULAR MEMBERS, MEANS CONNECTING SAID TUBULAR MEMBERS WITH ONE POSITIONED WITHIN THE OTHER AND WITH THEIR DISTAL ENDS ADJACENT TO EACH OTHER AND FORMING A CIRCULAR ORIFICE THEREBETWEEN, A THIRD TUBULAR MEMBER REMOVABLY CONNECTED ADJACENT TO ONE END THEREOF TO THE PROXIMAL END OF THE INNER TUBULAR MEMBER, AN OPTICAL LENS CLOSING SAID THIRD TUBULAR MEMBER FOR VIEWING AN AREA PRESENTED TO THE DISTAL END OF SAID INNER TUBULAR MEMBER, MEANS CONNECTED TO AND EXTENDING INTO SAID THIRD TUBULAR MEMBER INTERMEDIATE THE ENDS THEREOF FOR ILLUMINATING SAID AREA, A FLUID CONDUIT CONNECTED TO SAID THIRD TUBULAR MEMBER AND COMMUNICATING THERETHROUGH WITH THE INTERIOR OF SAID INNER TUBULAR MEMBER, MEANS CONNECTED TO THE OUTER TUBULAR MEMBER ADJACENT TO THE PROXIMAL END THEREOF AND COMMUNICATING THROUGH THE SPACE BETWEEN SAID TUBULAR MEMBERS WITH SAID ORIFICE FOR SELECTIVELY CONNECTING THE SAME TO A SUCTION DEVICE AND A SOURCE OF FLUID UNDER PRESSURE, THE DISTAL END PORTION OF THE OUTER TUBULAR MEMBER OVERHANGING THE CORRESPONDING END OF SAID INNER TUBULAR MEMBER AND FORMING AN OPENING WHICH IS SMALLER THAN AND SPACED FROM THAT AT THE END OF SAID INNER TUBULAR MEMBER. 